In vitro effect of new antibiotics against clinical isolates of salmonella paratyphi A

Objective: The objective of this study was to determine in vitro MIC patterns of various therapeutic alternatives for the treatment of Salmonella Paratyphi A. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology Rawalpindi, from Jun 2012 to May 2014

Material and Methods: Clinical samples were collected from suspected cases of salmonella infections. Culture was applied on Bactec 9050 special and/or standard media. Suspected Salmonella Paratyphi colonies were tested by API 20E and confirmed by serology. The isolates were also tested for resistance to ampicillin, cotrimoxazole, ciprofloxacin, ceftriaxone, doripenem, imipenem, ertapenem, aztreonam, moxifloxacin, cefpirome, cefepime, gatifloxacin, and chloramphenicol by Kirby-Bauer disc diffusion method. MIC [Minimum Inhibitory concentration] was done on MDR and ciprofloxacin intermediate or resistant cases by E-strips

Results: One hundred and eleven isolates of Salmonella Paratyphi were recovered from 2230 specimens. Resistance by disk diffusion technique noted in Salmonella Paratyphi A was ampicillin 60%, chloramphenicol 40%, cotrimoxazole 38%, ceftriaxone 7.9%, ciprofloxacin 8%, cefpodoxime 7.9%, imipenem and ertapenem 2.6%, aztreonam 1.3%, moxifloxacin 6.6%, and gatifloxacin 1.3%. No resistance was noted for doripenem and cefepime. MIC50 was 0.094 for Cefpirome, 0.125 Aztreonam, 0.25 imipenem and tigecycline, 2 cefpodoxime and 8 for azithromycin

Conclusion: Azithromycin, Aztreonam, Imipenem, tygecycline, cefpodoxime and cefpirome are potential therapeutic agents for resistant Salmonella Paratyphi A infections

In vitro effect of new antibiotics against clinical isolates of Salmonella Typhi

Objective: to determine the in vitro disk diffusion and MIC patterns of the therapeutic alternatives for Salmonella Typhi

Study Design: a cross-sectional study

Place and Duration of Study: armed Forces Institute of Pathology, Rawalpindi, from June 2011 to May 2013

Methodology: clinical samples were collected from suspected cases of Salmonella infections. Culture was obtained on standard media. Suspected Salmonella colonies were tested by API 20E and confirmed by serology. The isolates were tested for resistance to various antibiotics by Kirby-Bauer disc diffusion method. MIC was done on MDR and ciprofloxacin intermediate or resistant cases by E-strips for selected antibiotics

Results: one hundred and twenty-eight isolates of Salmonella Typhi were recovered from 2230 specimens. Resistance by disk diffusion technique was 72% for ampicillin, 41.2% for cotrimoxazole, 38% for chloramphenicol, 8% for ciprofloxacin, 4.7% for cefpodoxime, 3.5% each for ertapenem aztreonam and moxifloxacin 2.4% for ceftriaxone and 2.3% for doripenem. No resistance was noted for imipenem, cefepime and gatifloxacin. Imipenem MIC[90] was 0.38 and MIC[50] was 0.25. For cefpirome, MIC[90] was 0.64 and MIC[50] was 0.09. For aztreonam, MIC[90] was 0.12 and MIC[50] was 0.09. For cefpodoxime MIC[90] was 0.75 and MIC[50] was 0.38. For azithromycin, these values were 16.0 and 7.0; and for tigecycline they were 0.25 and 0.09

Conclusion: imipenem, azithromycin, tigecycline, aztreonam, cefpodoxime and cefpirome are potential therapeutic agents for resistant Salmonella Typhi infection

Awareness of hepatitis 'B' among people of khyber pakhtunkhwa province of Pakistan

Hepatitis B virus is causing serious health concerns in countries like Pakistan. In Khyber Pakhtunkhwa province, 0.6 milion people were estimated to be infected with this virus in 2008. The authors aimed to assess knowledge regarding vaccination, testing and routes of transmission of hepatitis B virus among people of Khyber Pakhtunkhwa, as such knowledge among masses will help limit the infection. People belonging to 12 different districts of Khyber Pakhtunkhwa province were interviewed over a period of 5 months from October 2013 to February 2014. A pre-tested questionnaire was used and in-person survey of randomly selected 1,938 people was carried out throughout the province. Ninety-nine percent people said they knew about hepatitis B virus and 42% said they had got tested for it too. Out of them, 63.2% knew that a vaccine is available for hepatitis B virus. The proportion of respondents, who said hepatitis B virus can spread by sharing razors, toothbrush, syringes or sexual contact, was 97.94%, 95%, 99.3% and 77%, respectively. Only 28.7% knew, it can also spread vertically from mother to child during childbirth. People were quite aware of the routes of transmission of this disease, but they lacked knowledge regarding vaccination and prevention of this menace. Settings should be set up where routine preventive care and immunization services are provided

Pattern of dermatophytes among dermatological specimens at AFIP, Rawalpindi

To determine the types and prevalence of dermatophytes from the clinical specimens received at Armed Forces Institute of Pathology [AFIP]. Study design is descriptive. The study was carried out at the Department of Microbiology, AFIP Rawalpindi from June 2009 to May 2010. Total of 400 different clinical specimens were dealt during the study period. After direct microscopy, they were inoculated on Sabouraud's dextrose agar with and without antimicrobials. The plates were incubated at 220C and examined twice weekly up to four weeks for any fungal growth. Species identification was done through colony morphology and microscopic examination of lactophenol blue preparation. Out of total specimens, 221[55.25%] yielded fungal growth. The overall yield of dermatophytes from different specimens was in the order of nail [78%], followed by skin [18.3%] and hair [3.3%]. Mycological infections have growing importance because of the increasing population of immune-compromised patients warranting a high index of suspicion

Non-dermatophyte moulds as pathogens of onychomycosis

To determine the role and pattern of non-dermatophyte moulds as causative agents of onychomycosis. Case series. Department of Microbiology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from November 2009 to July 2010. Nail clippings and nail scrapings were obtained from abnormal looking nails with treatment and detection failure for onychomycosis. Microscopic [40% potassium hydroxide mounts] examination and culture on Sabouraud's dextrose agar [SDA], SDA containing chloramphenicol, and SDA containing actidione and chloramphenicol were used for species identification. Non-dermatophyte moulds were isolated from 32 out of the total 47 culture positive cases [68%]. Alternaria alternata was the commonest species [46%]. Dermatophytes were isolated from only 7 patients [15%] belonging to genus Trichophyton. Yeasts were isolated in 8 [17%]. There was no fungal growth in 53% of cases. The non-dermatophytes should be considered important in evaluating the culture negative cases for dermatophytes as well as those cases ending up in treatment failure after empirical treatment for dermatophyte infections

Vancomycin resistant enterococcal sepsis in an acute myeloid leu kemic patient

Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloid leukemia. Patients with acute myeloid leukemia are at increased risk of acquiring vancomycin resistant enterococcal infection and its treatment remains problematic. Vancomycin therapy for more than 7 days is usually associated with inducible vancomycin-resistant enterococcal infections. We report a case of vancomycin resistant enterococcal sepsis in a patient of acute myeloid leukemia

Frequency and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus

To determine the frequency of methicillin resistant Staphylococcus aureus and its antimicrobial susceptibility pattern in patients reporting to Combined Military Hospital [CMH], Pano Aqil. A non-interventional, cross-sectional study. Pathology Laboratory, Combined Military Hospital [CMH], Pano Aqil, from December 2005 to January 2008. Strains of Staphylococcus aureus were isolated from a variety of clinical specimens. Standard methodology, using modified Kirby-Bauer disk diffusion method, was adopted for antibiotic sensitivity test. The MIC of oxacillin and vancomycin was performed by E-strips, for MRSA isolates and isolates revealing vancomycin resistance on disk diffusion. A total of 195 hospital and 42 community acquired isolates were tested. Forty-seven [19.8%] non-duplicate strains were found to be methicillin resistant Staphylococcus aureus [MRSA]; methicillin resistance did not differ among hospital strains [n=42] as compared to community ones [n=5, p=0.1555]. No isolates from the community and hospital acquired showed resistance to vancomycin. Community and hospital acquired isolates revealed higher resistance against penicillin and doxycycline than against ciprofloxacin, erythromycin, gentamicin and chloramphenicol. However, resistance against these antibiotics did not differ significantly among community and hospital acquired isolates. Increase in prevalence of MRSA is impending in future, appealing preventive measures to be adopted. However, Staphylococcus aureus resistant to vancomycin was not observed

Percentage of hepatitis B and C among young adult males from interior Sindh

Present study was planned to know the seropercentage of Hepatitis C Antibodies and Hepatitis B Surface Antigen in a population based sample of healthy male army/naval recruits from rural Sindh. Laboratory based non-interventional, descriptive study. Conducted at Combined Military Hospital Pano Aqil from 1st January 2006 to 31st October 2006.A total of 5237 healthy male recruits from various districts of interior Sind were studied. HBsAg and Anti-HCV were tested by Immunochromatographic assay and positive tests were confirmed by ELISA method. The percentage of anti-HCV was [4.37%] and was [7.39%] for HBsAg. The percentage of HBsAg in districts Nowsheroferoze [10.11%], Ghotki [9.21%] and Khairpur [7.48%] and Anti-HCV [p<0.0001] in districts Nawabshah [9.32%], Khairpur [6.71%] and Ghotki [6.64%] respectively was higher than the other districts. Both the viruses are evenly distributed among the remaining different Districts` population. There is considerable threat of HBV and HCV in interior Sindh. Screening of selected groups and vaccination against Hepatitis B may be considered in these areas. Health education to general public including barbers would be the key for control/prevention of these dreadful diseases

Borrelia recurrentis as a cause of high grade fever in Rawalakot, Azad Kashmir

A descriptive study was conducted at Combined Military Hospital Rawalakot, Azad Kashmir to determine the frequency of Borrelia recurrentis. Both out door and indoor cases were included. A total of 80 febrile patients with temperature above 1000C were studied. Cases showing any other cause of fever on routine / available tests were excluded. Borrelia recurrentis was sought by Giemsa stain. All positive cases were treated with Doxycycline. Nine cases were positive [11.25%]. Treatment response was 100%. Borrelia recurrentis is found in a significant number of febrile cases at Rawalakot Azad Kashmir

outbreak of viral hepatitis E

An outbreak of acute hepatitis E virus [HEV] infection occurred from the beginning of June 1998 till the end of July 1998 at one of PAF bases in Karachi. The epidemic was water borne and confined to base personnel out of whom 204 hospitalized icteric patients were studied. The clinical course was mild and short without any progression to fulminant hepatitis or death. All cases were tested for hepatitis B surface antigen [HBsAg], 10 for hepatitis C virus antibodies [Anti-HCV] and HEV antibodies [Anti HEV]. Anti HCV was negative in all the cases and Anti HEV was positive in all the tested cases. The need for an easily available, inexpensive serological test for HEV infection, protection of water supplies from fecal contamination, adequate chlorination and/or boiling of drinking water and health education about personal and environmental hygiene, especially in communities at high risk is stressed